Abstract
Introduction
Foraminal and extra-foraminal lumbar disc herniations are uncommon. Main presentation is radicular pain related to the exiting nerve root in the affected level. Different approaches for surgical intervention include median or para-median open microscopic-assisted techniques, endoscopic approach or trans-tubular microscopic-assisted percutaneous technique.
Patients and Methods
Between October 2012 and March 2014, 40 patients (18 females and 22 males) with foraminal or extra-foraminal lumbar disc prolapse were operated on in our center. Extra-foraminal percutaneous trans-tubular microscopic-assisted approach was used. Preoperative investigations included plain radiographs and MRI. Preoperative clinical evaluation included Visual Analogue Scale (VAS) for radicular pain and neurological state. The mean follow up period was 18 months (range 12 - 30).
Results
The mean age was 56 years. The most commonly affected level was L4/5 (22 patients = 55%). The mean preoperative VAS for leg pain was 82 mm, improved to 15 postoperatively. The average operative time was 69 minutes. There were no intraoperative complications. One patient had temporary postoperative quadriceps weakness (L4 radiculopathy) that was completely improved at 3 months follow up. Another patient had deep venous thrombosis after discharge and he was readmitted. Two patients had recurrence within the first 6 months postoperatively. They were re-operated using the same technique without complications. Both were followed up for one year without a second recurrence. Two patients with primarily severe degenerative changes and neuroforaminal stenosis had recurrence of symptoms with back pain and leg pain, re-operation as Transforaminal Lumbar Interbody Fusion (TLIF) was done
Conclusion
Trans-tubular percutaneous extra-foraminal microscopic-assisted nucleotomy is advantageous for foraminal and extra-foraminal disc herniations. It is a muscle splitting minimal-invasive approach with minimal morbidity. Re-operation rate is not different compared with microsurgical open or endoscopic techniques. Results seems to be better in cases with sequestrated disc lesion rather than degenerative neuroforaminal stenosis.